Hydration in ICH

Q: All of the following are part of first 24 hours treatment in patients with intracranial hemorrhage (ICH) except? 

A) Treat fever and try to achieve normothermia
B) Treat hyperglycemia and keep serum glucose level below 180 mg/dL
C) DVT prophylaxis via intermittent pneumatic compression
D) IV hydration with 0.45% sodium chloride (half normal saline)
E) Keep NPO to avoid aspiration pneumonia



Answer: D

Hydration with half normal saline should be avoided. Instead normal saline (0.9% sodium chloride) should be used which is isotonic.  Hypotonic fluids may make cerebral edema worse and may increase intracranial pressure. Similarly, normovolemia should be the target as hypervolemia may also worsen cerebral edema.

#trauma
#neurology



Reference:

Manno EM. Update on intracerebral hemorrhage. Continuum (Minneap Minn) 2012; 18:598.